Determinants of Mammography Screening Participation in Adult Childhood Cancer Survivors: Results From the Childhood Cancer Survivor Study

Abstract

Purpose: To identify treatment, intrapersonal, and provider factors that influence childhood cancer survivors' adherence to recommended mammography screening.Design: Secondary analysis of data derived from 3 consecutive surveys within the Childhood Cancer Survivors' Study.Sample: Female childhood cancer survivors: N = 335, mean age = 30.92, mean years after diagnosis = 21.79. Methods: T-tests and structural equation modeling. Main Research Variables:Mammogram recency, health concerns, affect, motivation, survivorprovider interaction.Findings: Forty-three percent of the variance was explained in mammogram recency. Survivors most likely to follow the recommended mammogram schedule were directly influenced by cancer treatment exposure to mantle radiation (p = 0.01), less intrinsic motivation (p = 0.01), positive affect (p = 0.05), recent visits to oncology clinic (p = 0.01), discussion of subsequent cancer risks with physician (p = 0.001), perceptions of more severe late effects (p = 0.05), age ≥ 40 years (p ≤ 0.001), and having received a print media intervention detailing breast cancer risks and follow-up strategies.Conclusions: Perceived symptoms, motivation, affect, provider influences, readiness for medical follow-up, and knowledge of treatment exposures are potential modifiable targets for intervention to support mammography screening in childhood cancer survivors at risk. KEY POINTS Although female childhood cancer survivors are at increased risk of breast cancer as a result of treatment exposures, they do not adhere to the recommended schedule for mammography screening. Intrapersonal (motivation, affect, concerns), contextual (symptoms, treatment exposures), and provider (survivor-provider relationship and discussions) factors are strong influences for adherence to mammography screening. Nursing interventions to support mammography screening in survivors should: (1) consider the impact of motivation, affect, and level of readiness for follow-up on health behavior; (2) provide written summaries of treatment exposures and the recommended interval for mammography screening at treatment completion and throughout follow-up; (3) identify specific fears, anxieties, and misconceptions that may prevent adherence to mammography screening. NIH Public Access

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